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Chick-fil-A operating at DoorDash Kitchen in Redwood City

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While representatives for Chick-fil-A are set to open a “freestanding Chick-fil-A restaurant in Redwood City in 2020” (the San Mateo Daily Journal broke the story that its permit to operate at 536 Whipple Ave. was approved last month), it turns out local residents can already access its menu.

The fast-food chain has quietly begun operating from DoorDash Kitchen in Redwood City, offering pickup and delivery service from San Mateo to Sunnyvale. By now, of course, the local and national media have caught on.

In October, DoorDash launched the shared commissary kitchen with multiple restaurants at 1531 Main St. in Redwood City. Other restaurants serving from the shared kitchen are Nation’s Giant Hamburgers, Rooster & Rice, Humphry Slocombe, and The Halal Guys.

The Chick-Fil-A menu can be found on the DoorDash site here.

DoorDash Kitchens in Redwood City

This, of course, is happening several months after news that Chick-fil-A faced opposition in the community over possible plans to open in Redwood City.

The fast food chain has faced criticism for donating to organizations accused of having anti-LGBTQ+ views. Today, Chick-fil-A is making a new set of national headlines over its announcement it has changed its focus on charitable giving. Per the Washington Post, the changes include discontinuing controversial multiyear commitments with two religious groups, Fellowship of Christian Athletes and the Salvation Army. The chain said it will “deepen” donations to a smaller number of organizations that work in the areas of education, homelessness and hunger. Those organizations “could include faith-based and non-faith-based charities,” the company said.

Will such decisions quiet the fury a Chick-fil-A restaurant in Redwood City?

At this point, Chick-fil-A reps sound optimistic.

“We look forward to joining the community and serving all of our guests delicious food in an environment of genuine hospitality,” representatives said in the statement.

Putting pumpkin pie spice on ice

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If you were with us around this time last year you may remember that I railed, not ever so slightly, against all things “pumpkin spice.” Why? I hold that “pumpkin spice” is an overly used, oft-abused “flavor.” But here’s the thing, I still love pumpkin. Real pumpkin, that is. Pumpkin curry, pumpkin pie, pumpkin bread, and yes, pumpkin ice cream. Because when it’s still 80 degrees in early October and it feels like summer will never acquiesce to fall, ice cream in November is not that far-fetched an idea. Especially when it’s rich, creamy, and the flavors — pumpkin, ginger, cinnamon, a few cracks of black pepper — come together in such pure pumpkin concert that you can, if not for the briefest of moments, imagine a world where pumpkin spice air fresheners don’t actually exist.

This recipe, which is simultaneously homey and sophisticated, is courtesy of Chez Panisse-alum, David Lebovitz. He was named one of the San Francisco Chronicle’s Top Five Pastry Chefs in the Bay Area, and there is never really any reason to doubt his recipes — this one included. While I first started making his pumpkin ice cream with fresh pumpkin that I would roast and puree myself (they were simpler times), even Lebovitz himself says canned pumpkin will do. Just get pure pumpkin, not pumpkin pie filling, as the latter will have spices and sweeteners added in.

This ice cream is, simply put, the fall season in dairy form. Serve it at Thanksgiving with ginger snaps or just keep it on hand for when you need a break from the pumpkin spice takeover. But do make it. You won’t regret it.

David Lebovitz’s Pumpkin Ice Cream

Makes about 1 quart


1 1/2 cups (375ml) whole milk

1 cup (250ml) heavy cream

1/3 cup plus 2 tablespoons (95g) granulated sugar

big pinch of salt

5 large egg yolks

3/4 cup (180g) fresh or canned 100% pure pumpkin puree

(not pumpkin pie filling, which has spices and sweeteners added)

1/4 cup packed (60g) dark brown sugar

1/2 teaspoon vanilla extract

1/2 teaspoon ground cinnamon

1/2 teaspoon ground dried ginger

a few turns of ground black pepper

optional: 2 teaspoons whiskey or brandy


1. Make an ice bath by putting some ice and water in bowl that is large enough for a medium, 2-quart bowl to nest inside of it. Place a sieve on top of the medium-sized bowl.

2. Measure the cream into the medium bowl nested in the ice bath. In another bowl, whisk the egg yolks.

2. In a medium saucepan, warm the milk, granulated sugar, and salt.

3. Once the sugar is dissolved and the milk is starting to simmer, turn off the heat and, while whisking the egg yolks constantly, pour about half of the warm milk into the eggs. Do not stop whisking the eggs while pouring. This process is called “tempering” and it prevents the eggs from cooking as soon as they’re introduced to the hot milk.

4. Scrape the tempered yolks back into the saucepan and cook over low heat, stirring constantly and scraping the bottom with a heatproof spatula. Really make sure to scrape the bottom and sides of the pan — you want to make sure everything is cooking evenly. The mixture will start to thicken. You’ll know it’s ready when you pull the spatula out from the mixture and run your finger in a line down the spatula. If the trail of your finger stays, the mixture is the right thickness and you’re good to go.

5. It’s ice bath time. Grab the sieve if it’s not already nested on the medium bowl with the heavy cream. Pour the mixture through the sieve and right into the heavy cream.

6. Stir until the mixture (which is now a custard) is cool. This may take a few minutes and you may need to replenish the ice.

7. Freeze in your ice cream maker according to the manufacturer’s instructions.

8. Pull the bowl out of the ice bath and wipe the bottom so no ice water gets into the custard during the next step.

9. Pour the cooled custard into a blender with the pumpkin puree, brown sugar, vanilla, cinnamon, ginger, pepper, and whiskey or brandy, if using. You could use an electric hand mixer if you don’t have a blender handy. Mix well.

10. Cover and chill thoroughly in the refrigerator, preferably overnight.

This story was originally published in the November print edition of Climate Magazine. 

Large-scale bust targets unlicensed dealers of guns, drugs

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It wasn’t an ICE operation. Rather, a large-scale law enforcement effort last week that resulted in the arrests of over two dozen people — including nine San Mateo County residents — targeted illegal possession and dealing of guns and drugs, authorities say.

The operation, which was spearheaded by the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) and which involved over a dozen law enforcement agencies, reportedly sparked concern in San Mateo County that local undocumented immigrants were being targeted. But the U.S. Attorney’s Office says the operation was “years in the making” and derived from an investigation into illegal gun and drugs activity by the ATF and San Mateo County Gang Intelligence.

During the operation, more than 130 firearms, 39 pounds of methamphetamine and about 20 pounds of marijuana were seized, the U.S. Attorney’s Office said.

Among those arrested on charges of conspiring to deal firearms without a license were Jose Buenrostro, 30, of Redwood City; Francisco Nunez-Nepita, 21, of East Palo Alto; William Alexis-Villa, 22, of Menlo Park; Erizondo Mora-Tapia, 25, of East Palo Alto; and Jonathan Robert Figueroa, 25, of Redwood City.

Among those arrested on charges of dealing and/or possession of methamphetamine were Francisco Garibay, 21, of South San Francisco; Jonathan Flores, 20, of San Mateo; Buenrostro; and Cristian Rafael Morales, 23, of San Mateo.

“Guns and drugs are a dangerous combination,” U.S. Attorney David Anderson said. “Public safety demands the kind of law enforcement cooperation we see in this enforcement action.”

San Mateo County wins grant for new Multiple DUI Court

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San Mateo County’s relatively new Multiple DUI Court, which aims to ensure DUI offenders don’t reoffend, received a $300,000 California Office of Traffic Safety grant for a third straight year.

In operation for just over one-and-a-half years, MDUI Court has had thus far 421 participants and an 87 percent graduation rate, with less than 1 percent of total participants committing a new DUI offense while under program supervision, the county said.

“This collaborative court assists driving under the influence offenders in achieving and maintaining sobriety, while adopting pro-social behaviors, to greatly enhance public safety in San Mateo and neighboring counties,” said San Mateo Superior Court Judge Donald J. Ayoob, who supervises MDUI.

The grant supports the administration and operation of court programs that provide intensive supervision of second and third time DUI offenders “while simultaneously connecting them with the recovery resources they need to address their substance abuse and achieve stability in their lives,” county officials said.

In addition to serving a jail sentence, participants are assigned dedicated probation officers; given referrals to community-based organizations for substance abuse treatment and social support; recieve ignition interlock devices for vehicles, preventing intoxicated individuals from starting the car; receive periodic alcohol testing or continuous remote alcohol monitoring; and have frequent hearings before a judge who reviews their progress and adjusts the program elements as needed.

“MDUI Court is a collaborative effort between the San Mateo Superior Court and County justice partner agencies including the District Attorney’s Office, Probation Department and Behavioral Health and Recovery Services,” the county said.

Not faux news: Yes, Virginia, a Christmas tree company grows in downtown Redwood City 

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Balsam Brands, a home décor and consumer products company whose roots, as it were, go back just over a decade, is a rare breed of business. Best known for its Balsam Hill artificial Christmas trees, the company headquartered in Redwood City has taken the artificial Christmas tree industry by storm. And, almost as notably, it’s done so without venture capital backing.  

But there’s more to the story of this unicorn that refuses to buy into the industry of Silicon Valley unicorns. Founder and CEO Thomas “Mac” Harman doesn’t just have a vision for business growth, he has a vision for the growth and happiness of his 250-plus employees. 

 The route to producing trees — the beautiful, artificial kind using his True Needle™ technology — came through a love of the real thing. An avid hiker and skier who holds an undergraduate degree in environmental studies, Harman has spent a lot of time amongst trees. “I have spent so much of my time in nature,” he said. “… I was well set up to design trees. If I went through my photo reel on my phone, you’d see that I document interesting trees, all the time.”  

Still, it might seem like a leap from loving real trees to designing and manufacturing fake ones. Especially Christmas trees, since the real-versus-artificial question can ignite holiday debates on par with the whole-berry-versus-jellied-cranberry-sauce conundrum.   

But Harman has a spot in his heart for both kinds of trees. “I grew up with real trees,” he said, and added, “I love Christmas, I love Christmas trees.” When he started dating Stephanie, the woman who would become his wife, though, he was introduced to a different family tradition: the fake Christmas tree. Harman laughed as he recalled Stephanie’s ersatz tree. “It just wasn’t very good. I think I’ve called it anemic … It was just so not awesome, compared to a real tree.”  

That underachieving Christmas tree planted a seed for Harman. “I was just like, how come we have Avatar, or you know, all this amazing Lucas Film stuff … but no one has ever made a good-looking artificial Christmas tree?”  

That question would percolate for years until June of 2006. Harman, then a recent graduate of Stanford’s Graduate School of Business, decided to capitalize on the market opportunity. He developed his True Needle technology, the full-bodied, as-seen-in-nature pine needles that put the flat, papery, single-toned “needles” of most fake Christmas tree to shame. He just needed a manufacturer which could produce the trees — and quickly: He only had three and a half months to get ready for that year’s Christmas season.  

 Harman did it all — designed and manufactured the trees, opened a pop-up shop at Stanford Shopping Center, and started an online, direct-to-consumer business —- in less time than it takes to turn out a Christmas fruitcake. Equally remarkable, he did it without venture capital funding. Harman shouldered the $2.6 million start-up and manufacturing cost with the help of family and friends.  

“I was totally naïve,” Harman told an interviewer for McKinsey & Company, of which he is an alum. “I never felt like I was taking a huge risk, but looking back, I was crazy. I can’t believe I took that much risk.”  

As it turned out, the risk was worth it. Harman was running the business out of his Palo Alto apartment and wearing so many hats — salesman, marketer, customer service rep — that he would often fall asleep at his desk. But that first season brought in $3 million in sales. By the second year, his Christmas trees were decorating the holiday stage of “The Ellen Show.” Then came the first of what has become an annual Balsam Hill float in the Macy’s Thanksgiving Day Parade in New York City.  

Soon Balsam Hill also had achieved the status as the go-to Christmas tree for both television shows and musicians’ stages. “Most legendary musicians, at some point, record a Christmas album,” Harman said. ”And when they launch that Christmas tour, many of them call us because we can elevate their sets. We’ve done some great things across all different genres.” 

But the moment he knew he was onto something came well before Balsam Hill was receiving Hollywood recognition. Rather, it was from seeing his business start to take off.  “I’d say you know, waking up one day that first year and seeing the sales come in order by order on the computer,” Harman recalled. “I was just like wow, this is actually happening.” 

The success meant Harman had to change his plans. “I had this poorly educated thought that this would be a highly seasonal business in terms of demands on my time … I really thought this would be a side business to fund my other businesses,” he added, with a laugh. 

“It’s not that I was special,” Harman said in response to a question about Balsam Hill’s success. “It was right time, right place, and good search engine optimization.”  

Since those early years Balsam Hill has grown into Balsam Brands, which has offices in Idaho, Ireland and the Philippines, and expanded far beyond “Christmas.” Under the Balsam Brands umbrella, customers can shop for outdoor furniture, as well as spring, fall and Halloween décor. The product offerings range from beautiful serving ware to a years’ worth of wreaths and floral arrangements so real to the eye they have to be touched to know they’re artificial. But it’s not just the other seasons that have gotten the royal treatment: The tree line has also expanded to offer even more natural-looking trees, not just artificial versions of what one would find in a tree lot.  

“The trees that I’ve been working on the last five years are the trees that aren’t as manicured,” Harman said. “An example is our Yukon Spruce. It’s asymmetrical. Some of the branches are intentionally longer than the branches next to them.” These less-manicured trees, Harman admits, have had his manufacturers, most of whom are in China, scratching their heads. “They’re not used to it,” he said.  “They’re like, ‘Wait, this doesn’t look right.’ But that’s the point.”  

Growth of product isn’t Harman’s only motivation. “If we don’t grow, we don’t create opportunities for our team members to grow. We want to be a place where people come and invest a significant part of their careers. If we aren’t growing at least 10 percent, I don’t think we’re going to create opportunities for people to take more on and have more autonomy.” 

There is also a genuine commitment to culture at Balsam Hill. So genuine that they don’t have coffee in the office. There’s a strategy behind the absence of coffee. Harman wanted employees in downtown Redwood City to go out for coffee to keep them connected to the customer experience. It’s a good excuse, Harman contends, for team-bonding, not to mention the chance to get some fresh air. 

“I want our employees to go out, experience retail, customer service … to be reminded of what it’s like to be the customer. We’re an online company. I want to make sure we’re not locked away in an ivory tower somewhere.”  

That said, and while Harman says the policy may change, Balsam Brands does buy the coffee, providing gift cards to local coffee shops.  

The recently remodeled Redwood City headquarters, which is mainly home to the Balsam Brands merchandising team, sits above the Bank of America office on Jefferson Avenue. It is an open and inviting space which bears no resemblance to Santa’s Workshop. Even without venture-capital backing, the office has the makings of a proper Silicon Valley office: The kitchen area accommodates space for foosball, ping pong and family-style tables. The furniture hints at mid-century modern, but without feeling like it was all swiped from a “Mad Men” fire sale. Out in the open office space, Balsam Hill-branded Patagonia jackets and hoodies are slung casually over desk chairs. One of the small conference rooms has a desk bike.  

Though Christmas music is not piped through a sound system, homage is paid to the big guy in red: Half of the conference rooms are named after Santa: “Santa Monica,” “Santa Cruz,” “Santa Rose” … and so on.  

Harman said it is his father, who owned a parts manufacturing company, who inspired his own focus on his employees. 

“I grew up around the decisions and what I saw was how the number one thing my dad cared about was taking care of his employees,” Harman said.  When the late Harman died suddenly at age 50, Mac Harman was touched by the responses of people at the funeral. “Oh my gosh, the people came out of the woodwork to come share how he had done things for them, like, (things) we didn’t even know (about). He didn’t make a lot of money, he wasn’t super ambitious with the business, but it was all about taking care of people.”  

That sense of caring about people emanated from Harman with such sincerity that it started to soften even this writer’s Grinch-like stance against the faux holiday tree. But for those who still need to see to believe, check out the Balsam Brands warehouse in Burlingame. Now open to the public (see for more details) this is the place to immerse oneself in the Balsam Hill forest, capitalize on holiday décor sample sales, and just get excited about the holiday spirit — and there’s nothing artificial about that. 

 This story was originally published in the November print edition of Climate Magazine. 

Gun buyback scheduled for San Carlos next month

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A multi-agency Anonymous Gun Buyback event is set to be held in San Carlos on Saturday, Dec. 14.

The event will run from 9:30 a.m. to 2:30 p.m. at the end of Skyway Road.

Organizers are offering $100 for handguns and rifles and $200 for assault rifles, along with free gun locks and a raffle. The 102.9 KBLX crew is set to attend.

See the flyer below for more information.

This will be the third Gun Buyback event held in partnership with the San Mateo County Sheriff’s Office, and the Redwood City, San Carlos and Belmont police departments. The buyback events were initiated by the Citizens for a San Mateo County Gun Buyback, which worked to solicit funding for the events from multiple city and town governments in the county.

A buyback in May last year in Redwood City led to the collection of 427 guns. In December last year, 442 guns were collected at another event in Redwood City.

Measure H supporters brace for possibility of parcel tax’s defeat

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With Measure H, the proposed parcel tax aimed at supporting the cash-strapped Redwood City School District, still falling short of yes votes in the latest election count Tuesday, its supporters are bracing for the reality that it won’t pass.

The measure, a parcel tax of $149 per parcel annually for 12 years, experienced a slight uptick in approval after Tuesday’s count to 66.24 percent, just short of the required supermajority needed of 66.7 percent.

Results from a “small number” of Vote By Mail ballots that remain unreported are set to be released Friday, Nov. 15 and, if necessary, again on Tuesday, Nov. 19.

Measure H supporters don’t believe a defeat of the parcel tax, which would raise an estimated $3.45 million annually for the school district that is reportedly facing a $10 million deficit, would mean the effort went to waste.

“We ran an incredibly strong campaign that brought the District community together at a critical time and empowered emerging parent leaders,” said Jason Galisatus, executive director of the Redwood City Education Foundation. “We hope the outcome of Measure H serves as a call-to action to our parents and the Redwood City community at large that our kids need us to work together to support the District more than ever to put them on the path to success.”

On Facebook, Redwood City resident Lori Palmatier called upon the community to take action.

“Set up a GoFundMe, or just write a check donating to the school district,” she stated on Facebook, adding, “If you feel strongly that this is the way to save RCSD, then don’t let the outcome of this vote stop you.”

The stated purpose of Measure H is to attract and retain highly qualified teachers, support quality reading and writing skills in schools, maintain science technology, engineering and math instruction and reduce class sizes in kindergarten and first grade.

In 2016, Redwood City School District voters approved an $85 per parcel tax that raises $1.9 million annually.

Amourence Lee appointed to San Mateo City Council

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Following a tightly-contested vote Tuesday, San Mateo City Council appointed Amourence Lee to fill the council seat that became vacant on Oct. 30 following the resignation of former Deputy Mayor Maureen Freschet.

Lee will serve the remainder of Freschet’s four-year term, which ends Dec. 7, 2020. In November next year, voters will decide who will serve on the seat in the next four-year term.

At Tuesday’s special meeting, all council members described the applicants to fill Freschet’s seat — which included John Ebneter, Ellen Mallory, Brian Kelly, Lisa Diaz Nash, Robert G. Newsom and Lee — as qualified for the role.

The first council vote was split 2-2, with Mayor Diane Papan and Eric Rodriguez choosing Mallory and Rick Bonilla and Joe Goethals choosing Lee. In a subsequent vote, Papan selected Lee, breaking the stalemate.

“The competition was stiff,” said Papan. “Each of the applicants is a force of nature.”

Papan said Mallory, a longtime community advocate who is vice chair of Planning Commission, chair of the General Plan Subcommittee, and three-time chair of the Park & Rec Commission, would contribute to a smooth transition on council until the November 2020 election.

Councilmembers Rick Bonilla and Joe Goethals chose Lee not just for her experience but also because she represents an underrepresented North Central, where she’s highly active on the neighborhood council. A San Mateo resident for the last 10 years, Lee currently serves as vice chair of both the General Plan Subcommittee and Parks & Recreation Commission and is also known for spearheading the Love North Central Campaign that cleans up city streets.

While Mallory and the other candidates have great experience, Lee offers diversity on the council, according to Bonilla and Goethals.

“All of us live north of 92 and west of the railroad tracks,” said Goethals about existing council members. While Mallory is just as qualified, appointing Lee sends a message that voices from all parts of the community will be included, he added.

Lee is the co-founder of social enterprise startup Parents Clubs on Board in 2013, which was swiftly acquired by, and has also been a nonprofit executive. She’s currently a stay-at-home parent with two kids in the San Mateo-Foster City School District.

Stanford’s new, innovative tools to address chronic pain

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“In a world of hurt.” It’s a figure of speech not meant to be taken literally. But it’s a real place to those who inhabit the world of persistent pain, one whose moment-by-moment ramifications can upend and redefine life.  

There’s a continuum in this world of hurt: Pain is variable and many manage it themselves without going to the doctor. They can hold jobs and function, albeit through varying levels of pain. For others, severe chronic pain can mean an inability to sit comfortably, or far worse, to fall off to sleep at night, day in and day out. For some, pain brings an inability to work, to get out and see friends, to travel or to take in a movie. And, with those compounding, cascading inabilities, an ever-shrinking solitary “world” because of hurt.  

The threat of even more hurt must be defended against. “When you have chronic pain,” says 27-year-old Erika Delgado of South San Francisco, who has suffered with it her whole life, “it’s like constantly being in flight mode. You constantly feel that you’re in danger.”   

Often patients are reluctant to talk about pain that may send them to one doctor or therapist after another. Or pain that doesn’t have a clear diagnosis, or pain that doesn’t look obvious. They go stoic. “You adapt,” says “David,” a 68-year-old former executive who has been dealing with the after-effects of a sports injury and two back surgeries for two decades. “At some point, you’ve got to say that what you’ve got is what you’ve got.”  

Despite the constant burning sensation in his back, the healthy appearing Redwood City resident tries to cope with his chronic pain quietly — and, as much as possible, anonymously. “Nobody wants to acknowledge their disability,” says David, who nonetheless manages two contradictory things: an active schedule as a community volunteer – and usually only two hours of sleep a night.  

Except for those born with a rare congenital insensitivity which makes them literally feel no pain, everyone experiences it. A 2018 report for the U.S. Centers for Disease Control and Prevention estimated that 50 million Americans suffer from some form of chronic pain, and of that number, 19.6 million have pain severe enough that it frequently limits life or work activities. The economic toll is an estimated $560 billion in medical care, lost productivity and disability programs. The prevalence of pain, not surprisingly, goes up with age.  

Pain, however, is actually beneficial, warning of danger so people can respond, for example, by pulling a hand away from a hot surface. Episodes of acute pain go with the territory for stubbed toes and broken bones, but the symptoms usually resolve as the tissue heals or bones mend. Persistent, or chronic pain, on the other hand, can become a disease in its own right, as the nervous system over time becomes rewired, even spreading pain beyond the original area. That’s one of the reasons why it can be so challenging to treat and so frustrating to those who live with it. 

If there’s good news in all of this for Peninsula residents, it’s that advances are being made in better understanding the causes and effective treatments for pain, and with that the ability to offer more personalized approaches for targeting individual patients. Whether high-technology brain imaging, or no-tech therapies like breathing exercises and yoga, there are more alternatives available than just going home with a prescription for pain pills — something the nation’s opioid crisis has elevated as an urgent concern. 

Dr. Sean Mackey is chief of the division of pain medicine and director of neuroscience and the pain lab at Stanford University. He leads a multidisciplinary team which brings academic research findings into a clinical setting to help patients alleviate longstanding pain — and even to prevent pain, notably following surgery, from transitioning from acute to chronic. “Our message,” Mackey says, “is that you don’t have to suffer in silence, that there are approaches that can help.” 

Stanford Health Care’s Pain Management Center at 500 Broadway in Redwood City is one of the largest, most comprehensive pain centers in the United States, if not the world, according to Mackey, and has twice been designated a Center of Excellence by the American Pain Society. Physicians from multiple disciplines including psychiatrists, physical therapists, nutritionists and others get involved treating patients. 

Photo credit: Stanford

“One of the things that I think is unique to the Stanford program is that we integrate our research and clinical missions very tightly,” he adds. Clinical knowledge can feed researchers with questions to go after, and research discoveries are translated into safe, effective therapies. One example of something that is being tested is transcranial magnetic stimulation – “brain zapping” – using something like a coil placed on top of the patient’s head. “It doesn’t hurt,” Mackey says. “There’s no pain and you can induce a current through it that generates a magnetic field that can activate different brain centers, and we can turn on and off the brain systems that are associated with pain. And we’ve had some really good results with it.”  

Stanford has been recruiting volunteers for further study of the efficacy of TMS for two kinds of pain, one of several studies that are planned.  Another one is seeking evidence of the benefits of acupuncture for low back pain.   

The Stanford scientists also study novel applications for medications, according to Mackey, as an example, repurposing naltrexone, which was originally used to treat drug and alcohol addiction. “But at much lower doses, like one tenth of the usual dose, it has a completely different action,” he says. “It blocks nerve inflammation so it’s been very useful with fibromyalgia, which predominately affects women in their 30s, 40s and 50s, as well as some other chronic painful conditions.” 

Among the other new alternatives, Stanford is also using implanted devices that can override pain signals to a specific nerve and provide relief.  

If the body had only a single “pain center,” obviously treating pain would be much simpler, but many parts of the brain and neural pathways are involved in the pain experience. One of the problems when pain becomes chronic is that it can alter both the peripheral nervous systems and the brain and spinal cord “so that it amplifies the experience of pain and that magnifies it,” according to Mackey. When that occurs, someone who has come through an injury or surgery may no longer need the original signals to keep on feeling pain.  

What is experienced as pain relies on many sensory cues, among them emotions, beliefs, thoughts and expectations, and one of the factors that can feed into chronic pain is known as “catastrophizing.” The big word can apply to anything. Bills. The job. The country. But with pain, rumination, hopelessness and a feeling that the condition will never get better can trap the brain in an endless loop that is very difficult to break out of.    

But the pain is still real. Unfortunately, in part because it’s “invisible,” patients commonly report feeling they are being blamed for their pain, according to Stanford associate professor Dr. Beth Darnall, who has a doctorate in clinical psychology and is a pain scientist. “(It’s) a misperception that somehow people are saying pain is all in your head. ‘You’re making it up. It’s not real. There’s not a medical basis for your pain, therefore there must be something wrong with you’ … (But) all pain is real. I always say that at the outset. All pain is real.”  

One of her primary interests is in developing low-cost, accessible treatments that empower patients so they can “begin participating in managing their symptoms rather than feeling at the mercy of them” — among them cycles of poor sleep, persistent worry and feeling helpless. Darnall, who teaches a class on this at Stanford’s Redwood City clinic four times a year, says studies demonstrate that in two months or so of cognitive behavioral therapy, improvement can be shown. “They have evidenced substantial volumetric increases in the regions of the brain associated with brain control — so literally increasing the brain matter in those regions that associate better regulation of pain.”  

It’s long been established that cognitive and behavioral therapies are important in addressing chronic pain. “What’s different is that we’re now focusing more and getting people better access to what works,” she says. Rapid access to relief is “kind of where the rubber hits the road.” 

Pain physician and professor Dr. Ming-Chih Kao is chief of Stanford’s network of pain clinics (including the one in Redwood City), which is expanding geographically: Patients who are already in pain benefit because they don’t have to drive so far for treatments and can come in more often. 

Kao started his career in internal medicine, intending to focus on cancer as his specialty, but decided to switch to pain management – in part because of how common pain complaints are, headaches and back pain topping the list. “In the primary clinic that I saw … about 20 to 30 percent of my patients could benefit from a pain specialist,” he says. But the diagnosis and treatment of pain, he also saw, is very complicated and requires a team approach.   

When he started at Stanford as a fellow, patients routinely were coming in who had been prescribed very high dosages of opiates. Primary care doctors, he says, were trying to do the right thing to reduce pain but “the nature of opiate medications is that patients get used to it very quickly. They develop tolerance. … They had to escalate the dose again and again and again. And pretty soon, some patients are finding themselves taking astronomical doses. And still not getting pain relief.”  

Photo credit: Stanford

The issue has taken on new urgency as a result of the nation’s opioid crisis, which is commanding more public and regulatory attention. From a period when the drugs were overpromoted and the risks minimized, the pendulum has swung the other way, and in 2016 the Centers for Disease Control and Prevention recommended against opioids as a first-line treatment for chronic pain. There has been pushback from patients and physicians alike that things have gone too far the other way.  (Both Mackey and Darnall have spoken out against forced tapering of opioids.)  

Fortunately, Kao notes, there are new medications available that can be used safely to treat chronic pain, and many patients on large-dose opiates have been switching over successfully. There are 200-plus medications for pain management; 20 are opioids.  

With most patients who develop chronic pain, Kao observes, usually there’s not just one cause. It may start out with a herniated disk, nerve impingement, joint inflammation or a muscle or tendon issue. If pain persists and reaches a high level, secondary injuries from disuse or being bedbound can set in too.  

So for us, a patient coming in with back pain or a headache, we’ve got to figure out what parts of the pain cycle are important contributors to the chronic pain and then we try to tackle them one by one,” Kao says,” not just with the doctors but with the rest of our team.” 

Lifestyle changes can make a big difference. “Oftentimes patients find themselves essentially in a feedback loop where they become less and less active to avoid pain,” Kao says, “but unfortunately inactivity over long periods of time weakens muscles and that can cause secondarily more pain. So that’s actually the cycle we’re trying to break for a lot of patients.” The therapeutic prescription might include swimming, yoga, Nordic walking using poles, biofeedback and meditation and psychological counseling to improve coping skills and the ability to commit to a treatment program. 

San Mateo Medical Center – the county’s “safety net” hospital – offers a multidisciplinary pain clinic that includes similar therapies including meditation, physical therapy, yoga and art, as well as classes to help patients understand the physiology of pain. The program draws heavily on the work of Australian neuroscientist Dr. Lorimer Moseley, whose poplar and entertaining talks on You Tube help – as the title of one of his books puts it – “Explain Pain.”  

Clinic patient Douglas has the autoimmune disease fibromyalgia, which makes people hypersensitive to pain. Since she enrolled in the hospital’s program early this year, she feels better and has gained a new perspective about how the mind and the body are linked. “This class reminds us we’re not crazy,” she says. “Our pain is real.”  

It would be hard to find a more enthusiastic graduate than San Bruno resident John Acayan, a back pain sufferer who says the pain clinic has helped him get past being depressed about things he can no longer do and instead look forward to what he can do. “One of the things the pain management clinic has done for me is help me to realize that (if) you’re injured, perhaps you’re not going to be 100 percent the same, you’re not going to be able to do everything that you used to. But you can be happy. You can do other things.”   

He even tried acupuncture, and despite a fear of needles, “It was fantastic. I couldn’t believe it. It made everything go away. I’ll say literally the rest of that day was so tranquil. Absolutely no pain. Zero. That night, I slept fantastic.” The next morning was great, but after a few days the pain came back. He tries not to think about pain so much. At one time, in fact, he thought his medication needed to be stronger. He was taking 600 milligrams of tramadol a day and is now down to 50. The clinic team guided him to the realization that he didn’t need that much. “I could take a pill and be happy and lightheaded,” he says, “but that isn’t the way I want to feel. I want to feel normal. I don’t want to feel loopy.” 

This summer, Acayan got to try out something fairly new in the hospital’s treatment toolbox – virtual reality. Patients put on goggles and operate controls to throw things at friendly sea otters on a video screen and become completely engrossed. Another version has a biofeedback component that gives viewers some control as their heart rate changes.  

Chief Medical Information Officer Dr. Michael Aratow says virtual reality can calm people down in high-anxiety areas like emergency rooms. He brought the idea to Dr. Melissa Fledderjohann, a licensed clinical psychologist who directs the pain management clinic, and she readily agreed to offer it in her program. Most patients get a reduced pain sensation while they’re using VR, according to Fledderjohann. “We know that during and right after it, they definitely feel a decrease,” Aratow says. “The question is does that decrease persist until next time? The jury’s still out on that one.” 

Says Fledderjohann: “It helps reinforce the concepts in our classes, saying ‘There are tools you can do to manage your pain, reduce your pain. It’s not just an external thing that’s coming at you. You yourself can do your own pain management. And this would be a good example. By going though VR, you saw your pain reduced.’” 

Simon Koytiger, a physical therapist who manages Vibrant Care Rehabilitation in San Carlos, is also a proponent of a comprehensive and holistic approach to treating pain, which he views a symptom, not the root of the problem. Especially in the fast-paced Bay Area, lifestyle issues including lack of exercise, working long hours, stress, poor diet and anxiety can show up as back or knee problems, and Koytiger tries to help patients develop healthier habits. “We have this chronic pain issue,” he says. “Lifestyle is never going to show up on an MRI.” 

Exercise, he points out, helps reduce pain many ways, first by making people stronger and less fragile and improving the capacity of all tissues in the body.  Exercise also has endocrine effects, releasing the “happy hormones” serotonin and dopamine and reducing the production of the stress hormone cortisol.  

“I talk to patients about these three pillars very frequently: It’s physical exercise, it’s diet and nutrition and it’s mental health,” Koytiger adds. “And actually I’m a bit of a believer, even though I’m a physical therapist, that the primary pillar is mental health. Because who is the one who’s choosing to eat well? Who is the one who’s deciding to exercise that day or not? We make those decisions and if we are at ease and we have more peace and calmness in our minds, we are going to naturally do those things that are right for our body. If we are suffering with depression and anxiety and stress, it’s going to be much more challenging to balance those two domains.”    

Coming back from chronic pain can be a long haul.  

Woodside resident Brad Dary, 65, counts himself fortunate that he “came out the other side” of years of chronic pain, which began in 1995 with a laminectomy followed by fusion surgery for a vertebra five years later.  

For the first year after the surgery, “I felt like I was cut in half,” he says. “I moved home with my parents. I was literally in bed for a year after that operation. … It would take me about a half an hour to get from the bed to the bathroom. You can’t do anything without your back being involved. I used a walker.” He had to take morphine for the pain but “hated having a foggy brain” and couldn’t wait to get off of it.  

He tried acupuncture once but thought it was “silly.” But Dary, who is a videographer, says through a slow progression of pushing himself to do exercise and the healing process, he finally recovered. “You just fight it out,” he says. “My biggest thing was doing exercise and trying to build my muscles as best I could … Everyone’s situation is different. I had a lot of time to heal. It was 10 years.” Today he jogs three times a week and works out with weights.  He thinks having to work so hard to get where he is challenges him to be “more alive.” 

“Rose” – who did not want to be identified by her real name for this story – has made a remarkable comeback too from barely being able to get out of a hospital bed using a walker. The southern San Mateo County resident disciplines herself to walk two miles, three times a week and has worked up to doing 15 minutes on an exercise bike at the gym. She’s arrived at this point 15 years after a series of back surgeries over four years, the first to address stenosis and then two more that turned out to be needed because of damaged disks.  

When it all began, she had a job, but she had to give up working long ago.  

Patients tend not to do their physical therapy if it’s too painful, and she was prescribed fentanyl and vicodin to help her be better able to do the therapy she would need, which it did. “They put me on heavy opioids because they knew to get through years of it would be so painful because all of these core muscles were, waist to pelvis front and back, cut three times through three surgeries,” Rose explains. “So that is a huge amount of healing.”  

Fifteen years ago, her first pain management doctor assured her that it would easy to get off the opioids when the time came. “It’s no problem,” Rose clearly recalls him saying. “Literally, he told me ‘No problem. You just gradually step off the opioids.’”  

But when she had been on them for six years and was ready to start declining, she learned otherwise. It took three years of tapering to get off opioids, drugs so powerful that she had to cut back milligram by milligram, for a month perhaps and then wait two months to cut back again. Each time, she had to deal anew with increased pain, plus the jittery withdrawal symptoms. Her skin felt like it was crawling and she had no idea what it was until someone she knows who works with people in addiction explained it to her. 

“I’d never done drugs,” she says. “I didn’t know. I’m such an innocent Girl Scout.”  

She methodically tracked her dosage on an Excel spreadsheet. With such a plodding pace, it helped to be able to look back and confirm that she really was taking less. Rose says her current pain specialist is a Kaiser Permanente doctor who has been with her every step of the way and is her “cheerleader.” He emphasizes the importance to her of pacing activities, not overdoing and causing more pain that will trigger a desire for more opioids. Though she was already slender, when one of Rose’s physicians told her that losing five pounds would reduce the pain, she lost ten. “In my case,” she says, “it makes a huge difference.” 

More than anything, what has really gotten her through it all, says Rose, is her support system of her husband and friends and her Christian faith. A Bible study group from church met in her house when she could not get out, and it helped to know that they were praying for her. “Prayer is meditation,” she observes, “and the Bible study group was group therapy.” 

Rose’s advice to others with chronic pain? “From my experience, really slow is what does it,” she responds with a laugh, “like the old Aesop’s fable, the tortoise always wins.” 

 This story was originally published in the November print edition of Climate Magazine. 

Photo credit: Stanford

Redwood City native named San Francisco Giants’ new GM

in Featured/Headline by

Time to get a World Series ring for Mom.

Redwood City native Scott Harris, 32, said he’s “excited to come back home” during a press conference today announcing him as the San Francisco Giants’ 10th general manager.

A graduate of Menlo School in Atherton, Harris spent the past seven years with the Cubs, serving in the final two as assistant GM. He contributed to a Cubs team that went from losing 101 games in 2012 to making the postseason in four consecutive seasons (2015-2018), and earning the World Series championship in 2016.

That certainly pleased his father, Rob, who grew up in Chicago and turned Harris into a Cubs fan.

But Harris’ mom, Joanne, is from San Francisco and a Giants fan. As is his brother, Chris.

“I grew up in a split household,” Harris said, adding, “they divided the sons.”

Harris said the arrangement has put his nephew Teddy “in an awkward spot” as his dad loves the Giants and his uncle was working for the Cubs.

“Now, at least Teddy has a little more clarity,” he said.

After three straight losing seasons, the Giants hope Harris can help contribute to a turnaround of the organization in partnership with President of Baseball Operations Farhan Zaidi. Harris’ smarts, work ethic and determination were touted as reasons for optimism.

Harris played soccer and lacrosse in high school and club lacrosse at UCLA, where he graduated with a degree in economics. Upon entering the job market, Harris “wrote every team a letter, knocked on doors, attended meetings, did everything he could to find an opportunity” in a baseball organization’s front office. About a year after meeting with Major League baseball legend and former Giants general manager Al Rosen (a meeting secured by Harris’ grandmother Joan, according to the San Francisco Examiner), Harris landed an internship with the Washington Nationals, then got a job in baseball operations with the Cincinnati Reds, followed by a gig as coordinator for Major League operations for MLB.

At just 25 years old, he got a job with the Cubs, during which time he managed to earn his MBA at Northwestern.

“He loaded up his schedule with Saturday classes…at the end of the week, he would take a red-eye back to Chicago and made it work,” according to the Giants organization.

Harris said it’s a “privilege to come back home” and is humbled by the opportunity to join the Giants.

“I vividly remember what the game looks at the highest level by watching generations of Giants players come through Candlestick and this park. I’m really excited to reconnect with San Francisco. I’m excited to live in the city.”

Zaidi said the Giants are “thrilled in an executive of Scott’s caliber to help lead our baseball operations group,” noting his experience, contributions toward the championship-winning Cubs and, of course, his Bay Area roots.

“Our goal is going to be to get a ring for Mom, now,” Zaidi said. “Big Giants fan.”

Photo credit: SF Giants

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